It is time for James Okun to pick our brain and inform us on some important medical matters. You can show your support by buying his books or leaving a comment here if you like- Jeyran Main

James D. Okun, MD is a Phi Beta Kappa graduate of Duke University and of the Albert Einstein College of Medicine in New York. He is the co-author of The History of New Innovations in Modern Medicine and of Erasing Scars: Herpes and Healing.

Did you know that a mole can turn malignant, spread and lead to death if it is not diagnosed by biopsy and treated early? This condition is called metastatic malignant melanoma. Also, extremely important is prevention involving the use of appropriate sun blocks and avoidance of high-risk behaviors such as overexposure to the sun or improper use of tanning beds.

Malignant melanoma is a dangerous type of skin cancer and is what killed actor James Rebhorn of Showtime’s popular Homeland TV program at the age of sixty-five (www.dermacentermd.com).

Melanoma also killed famous singer Bob Marley at the age of 36 when a melanoma developed under one of his toenails. This type of melanoma known as “acral” or “hidden melanoma” develops in obscure areas of the body such as “the lining of the mouth, nose, and female genitals, and underneath or near fingernails or toenails.” (www.melanomaupdates.com/2014).

Per the American Cancer Society (www.cancer.org) melanoma is relatively rare and “accounts for only about 1% of skin cancers but causes a large majority of skin cancer deaths.”

The three layers of the skin consist of a surface layer and two deeper layers. The top protective and waterproof layer of the skin is the epidermis. The next deeper layer is the dermis which contains hair follicles and sweat glands. This layer is followed by the subcutaneous layer which is the deepest layer of the skin and contains fat.

The epidermis contains the melanocytes which produce the dark pigment melanin that leads to darkening of the skin. In melanoma, the melanocytes become malignant (cancerous) and if not caught early this type of skin cancer can metastasize (spread) to other parts of the body and can lead to death as in the case of Mr. Rebhorn and Bob Marley.

Under normal circumstances, the melanocytes like other cells in the body, divide and grow under cellular controls that control the rate of cell division. Growth rate and cellular restraint on growth are normally in a homeostatic balance. When cancer ensues, out of control cell growth eventually forms a tumor composed of melanocytes which are known as a melanoma (See The History of New Innovations in Modern Medicine Chapter 10). The cancerous melanocytes divide with abandon overwhelming the normal restraints against wild, out of control cellular growth.

One potential sign of a melanoma includes (www.cancer.org) the development of a new mole or spot not noticed previously. Additionally concerning is a mole that has changed in color, has borders which have become irregular, has become asymmetrical, has increased in size, or is in the process of changing or “evolving” in terms of size, shape, color, “feel” or borders, or is bleeding or cracking.

Common sites of distant spread or metastasis of melanomas include the lungs, liver, bones, and brain (www.melanoma.org).

Treatment options for melanomas include chemotherapy, radiation, surgical excision, and new types of targeted therapies in which drugs are specifically targeted to affect molecules in the tumor which control cell division and growth, based on genetic profiles, hopefully without affecting normal cells.

James D. Okun, MD is a Phi Beta Kappa graduate of Duke University and of the Albert Einstein College of Medicine in New York. He is the co-author of The History of New Innovations in Modern Medicine and of Erasing Scars: Herpes and Healing.